Oregon State Grange Matching Grant Program For the grant cycle opening July 1st Final Application deadline: September 15th

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1 Oregon State Grange Matching Grant Program For the grant cycle opening July 1st Final Application deadline: September 15th Before filling out a project application: Read and follow the Oregon State Grange Matching Grant Program Guidelines. Also, please remember the following: 1. Deadlines are firm and late applications will not be accepted: Final applications Original application must be submitted by September 15 th. Submit to: Oregon State Grange Master Oregon State Grange 643 Union St. NE Salem, OR The application provided must be used and submitted complete. Incomplete applications will not be considered for funding. Application components include: Project Information Page Project Narrative Attachments: o Project Schedule o Project Budget o o Match Pledge Form Attachments - may also include the following: location/site map documentation of donated cash or professional services documentation of estimates for purchases greater than $5,000 documentation of professional qualifications to justify professional rates 3. Staple the application materials together, in order. Do not bind or enclose in any folder. Double-sided copies are preferred. Attachments must be 8.5 x 11. Do not include loose photos, flyers, oversize documents, etc. 4. For final applications, submit one original application.

2 Oregon State Grange Matching Grant Program Date Received: Grange Name: Project Identification Information Grange Address: Briefly describe the project in 50 words or fewer: Grange Master: Applicant Information Project Contact: Mailing Address: Day Phone: The signatory below declares that s/he is authorized to act on behalf of the Grange, assures that a majority vote of the membership has authorized this project, and assures that any funds received will be used only for purposes set forth herein. Name: Signature: Address: Phone: Project Funding Request Grant funds requested: $ Value of Grange match (must be equivalent to request, at minimum): $ Total project value: $

3 Oregon State Grange Matching Grant Application Project Narrative In no more than 4 pages, using no smaller than 11 point font, please provide responses to the following questions. Grant reviewers respond best to clear, concise narrative. Project Description and Grange Benefit What do you want to do and why do you want to do it? Does the project meet a need that increases your standing in the neighborhood? How will it contribute to neighborhood identity, foster a sense of community and strengthen relationships? What is the lasting impact of your project on the Grange and the neighborhood? Project Readiness Who will handle the project accounting? If other than applicant, please identify and provide contact information. Briefly discuss your project budget and schedule. For physical improvements, how will long-term maintenance costs be addressed? Identify permits, fees and insurance requirements, if applicable, and how you plan to address them. Discuss qualifications of those providing professional services (documentation of professional qualifications must be provided to justify professional rates) Sustainability Values Describe how your Grange will benefit from the project. How does this project contribute to your neighborhood and/or community safety, and building community relationships? Discuss how the project contributes to community goals of environmental health and sustainability. Grange Match Briefly discuss how you have met or exceeded the program s match requirement.

4 Project Schedule List in chronological order specific steps you will take to carry out this project. Identify who will be primarily responsible for each step or activity. Estimate the month and year the step or activity will be completed. Projects should be completed within one year of the signed agreement with the Oregon State Grange. Step or Activity Person/Group Responsible Estimated Completion Date Date Completed

5 Project Budget Get estimates from more than one reliable source. Column B must match the total of the three columns All construction projects must include a 15% contingency. Items considered for the match (section C) must be documented. In C-Grange Match. Column D is to be used for additional monies not being used to match the funds of the OSG A B C - Grange Match D E Item Description Grant Volunteer Time In-Kind Contributions Other Sources (Not Total Project Cash Request ($22.14/hr) (supplies, materials or services) included w/match) (B+C+D=E) Personnel Supplies & Materials Services Other Items: Insurance Permits Contingency for all construction projects- 15% Other GRAND TOTAL

6 The project budget must include an amount of cash, in-kind donations, or volunteer time equal to or greater than the grant request. Volunteer labor or professional services contributed before the grant is awarded cannot be counted toward the match. All volunteer labor is valued at $22.14 per hour. Donated materials or supplies are valued at their retail price. The donors of professional services must also document the value of their contributions on official letterhead. Professional services are valued at their customary retail value. Match Pledge Form The Match Pledge Form provided must be used to document all volunteer labor and donated cash, materials or supplies. Use the form to collect pledges and then to account for the actual contribution. The last two columns are provided to verify that the pledged hours, goods or services were received. A project coordinator or other method of engaging volunteers may be desirable depending on the project. Name of Grange: The individuals, businesses, or organizations listed below commit to donate volunteer time, materials, services or cash for the above project. Name/Address/Phone Signature Description of Donation or Volunteer Role (include # hrs. pledged) Value of Item or Hours Value Received or Hrs. Worked Date & Initials

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